Editorial overview: Gastrointestinal: New frontiers in therapeutics for GI diseases and disorders — from microRNAs to novel pharmaceutics, to low FODMAP diets and microbiome

Abstract

While we have made great strides in developing new therapeutic strategies to treat certain GI diseases such as hepatitis C, much more is necessary! There is a dire need for new therapies for complex diseases such as motility disorders, IBD, obesity, cancer, constipation and diarrheal disorders, iatrogenic diseases such as postoperative ileus, visceral pain, GERD and other esophageal disorders. Because children are not small adults, the challenges are even greater in developing drugs for children and infants. As highlighted in this issue, gaps in our fundamental understanding of the basic mechanisms of some GI diseases also limit progress. Some examples include GI disorders, GI cancer, GERD, obesity and brain-gut disorders. More consideration should be given to placebo effects of drugs for GI therapies in clinical trials. Emerging areas include pharmacogenomics, the interaction between pharmacotherapy and gut microbiome, special diets (i.e. low FODMAPs), purinergic drugs, opioid mechanisms of drug tolerance and constipation and microRNA’s. Review in Gastroenterology of costs/morbidity associated with gut disorders and diseases provide a sobering reality of the magnitude of the problem and underscore the need for more options for treatment. There is an alarming trend for escalating costs for health care, to treat these illnesses and reduce morbidity and in some cases mortality (associated with colorectal and pancreatic cancer for instance). A recent review article in Gastroenterology (2015) by Anne F Peery et al. focused on the burden of GI, Liver and pancreatic diseases in the United States. They are a substantial burden and cost. There are an estimated 7 million diagnoses of GERD in one year in the ambulatory setting. Functional and motility disorders accounted for nearly 1 million emergency department visits in one year, and most of them were for constipation. Hospitalizations and associated charges for IBD, Clostridium difficile infection and chronic liver disease increased substantially over the past 20 years. The prevalence of immune-mediated conditions such as celiac disease and eosinophilic esophagitis (EoE) has also increased dramatically in the last 20 years, and emerging new therapies are in the horizon. Finally the leading GI cause of death is colorectal cancer. With this in mind, this issue covers selected high-impact recent advances in gastrointestinal disorders. These advances cover a spectrum of novel therapeutics and emerging drug targets for the functional GI disorders, intestinal and hepatic diseases, IBD and GERD. Non-conventional drug targets include micro-RNAs, low FODMAP diets, hypoxia-induced factor-2α (HIF-2α) and microbiobiome therapeutics. The spectrum of novel targets is shown in Figure 1. Open in a separate window Figure 1 New frontiers in therapeutics for GI diseases and disorders. Spectrum of novel therapeutics covered in the gastrointestinal section.